Mild Head Research Articles

Occurrences of avian encephalomyelitis virus in naturally infected chicks in Saudi Arabia's Eastern Province.

A neurological infectious viral disease, avian encephalomyelitis was initially discovered in 2-week-old commercial chicks in 1930 and classified as a neurotropic viral disease. A neurological outbreak caused by avian encephalomyelitis virus (AEV) in young chicks was first reported in Al-Ahsa in the Kingdom of Saudi Arabia (KSA) in 2010. The aim of this article is to examine the AEV in KSA, Al-Ahsa Province. Gizzard, proventriculus, cerebrum, cerebellum, and medulla oblongata tissue samples were collected from infected chicks for histopathology test and molecular identification. Infected chicks showed neurological signs particularly incoordination, mild head and neck tremors, stretching of legs, and lameness. The average morbidity and mortality rates were 35% and 10%, respectively. At necropsy, no obvious identifiable macroscopic lesions were found in the infected chicks. Nonsuppurative encephalomyelitis was found histopathologically in the central nervous system, mainly in the cerebral molecular layer. Microscopic lesions in the proventriculus showed masses of heavy numbers of small lymphocytes within the muscular layer. RT-PCR followed by sequence analysis revealed that The KSA strain (KJ939252) is intimately related to chicken European strains from Poland (KC912695) and the United Kingdom (AJ225173) with identity 99.6% than Chinese strains (AY225319, AY517471, and AY275539) with identity ranged between 94.6% and 95%. The phylogenetic tree analysis showed that the KSA strain is grouped in a similar clade with chicken European strains. The pattern of disease findings was typical of vertically transmitted AEV. The spread of AEV in Saudi Arabia is most likely due to the trade of birds and bird products with European countries.

Hounsfield unit measurement method and related factors that most appropriately reflect bone mineral density on cervical spine computed tomography.

Our study's purpose was to determine the most reliable Hounsfield unit (HU) measurement method to reflect bone mineral density (BMD) on cervical spine computed tomography (CT) and to identify any factors that influence these results. We retrospectively analyzed 439 consecutive patients with mild head and neck injuries. Mean HU values of the C2-C7 vertebra were determined on each sagittal, coronal, and axial CT image. Correlation patterns were analyzed between the HU value and corresponding dual-energy X-ray absorptiometry (DXA) in the lumbar vertebra (T-score) and femoral neck (T-score). A sub-group analysis was performed according to patient age, sex, and degree of spinal degeneration. The correlation coefficients for HU and DXA ranged from 0.52 to 0.65 in all cervical segments. A simple linear regression analysis revealed the following formula: T-score = 0.01 × (HU) - 4.55. The mean HU values for osteopenia and osteoporosis were 284.0 ± 63.3 and 231.5 ± 52.8, respectively. The ROC curve indicated that the HU method has a sensitivity of 89.2% and specificity of 88.7% to diagnose osteoporosis. The HU measurement showed a high correlation value (range: r = 0.64-0.70) with spine DXA score regardless of the degree of degeneration or patient age or sex. HU values using the upper two cervical vertebrae (C2 and C3) reflected a more reliable BMD level than other segments. Additionally, the HU of cervical CT provided reliable information regardless of measurement plane, age or sex, and degree of degeneration.

Is There a Need for an Observation Period in the Emergency Department after Mild Accidental Pediatric Blunt Head Injury?.

1. Introduction: The primary aim of this study was to determine the prevalence of a clinical status change during the ED observation period requiring a change in disposition. 2. Methods and Materials: This IRB approved prospective observational cohort study enrolled patients aged birth to 15 years old being evaluated within 6 hours of accidental blunt head injury with a Glasgow Coma Scale (GCS) >14 and normal neurological examination. The medical record was reviewed for a change in clinical status during the ED observational period. 3. Results: One hundred and twenty patients were enrolled into this study. One patient had a clinical status change (emesis) during the ED observation period representing a 0.8% clinical status change. No patient regardless of observation length or intervention(s) chosen by the provider had a change in disposition.

Modified decision-making rule supported by scheduled telephone follow-up reduces head computed tomography utilization in children with mild traumatic brain injury: A cohort study.

Unnecessary computed tomography utilization is common in children with a mild traumatic head injury. It is valuable to find a reasonable strategy for the patient's management.The aim of this study was to investigate the effect of scheduled telephone follow-up on computed tomography utilization in children with a mild head injury.A 2-year cohort study was performed. Children diagnosed with mild traumatic brain injury (TBI) were evaluated with a scoring system upon their arrival and during 1 month of scheduled telephone follow-ups by nurses. The rates of head computed tomography utilization, delayed imaging, and delayed diagnosis were analyzed.The rate of computed tomography utilization was 64.3% and 46.1% (P = .00) in the retrospective and prospective study periods, respectively. During the prospective study period, there were no differences in the rates of delayed imaging (2.3% vs. 2.2%, P = .814) or the rates of delayed diagnosis of significant radiological findings (0.1% vs 0.2%, P = .672) in cases with versus without immediate computed tomography.Adoption of a modified decision-making rule supported by scheduled telephone follow-up can reduce head computed tomography utilization without increasing the rate of missed or delayed diagnosis of clinically significant TBI in children with mild TBI.

Validation of the scandinavian guidelines for initial management of minor and moderate head trauma in children

BackgroundHead trauma in children is common, with a low rate of clinically important traumatic brain injury. CT scan is the reference standard for diagnosis of traumatic brain injury, of which the increasing use is alarming because of the risk of induction of lethal malignancies. Recently, the Scandinavian Neurotrauma Committee derived new guidelines for the initial management of minor and moderate head trauma. Our aim was to validate these guidelines.MethodsWe applied the guidelines to a population consisting of children with mild and moderate head trauma, enrolled in the study: “Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study” by Kuppermann et al. (Lancet 374(9696):1160–1170, https://doi.org/10.1016/S0140-6736(09)61558-0, 2009). We calculated the negative predictive values of the guidelines to assess their ability to distinguish children without clinically-important traumatic brain injuries and traumatic brain injuries on CT scans, for whom CT could be omitted.ResultsWe analysed a population of 43,025 children. For clinically-important brain injuries among children with minimal head injuries, the negative predictive value was 99.8% and the rate was 0.15%. For traumatic findings on CT, the negative predictive value was 96.9%. Traumatic finding on CT was detected in 3.1% of children with minimal head injuries who underwent a CT examination, which accounts for 0.45% of all children in this group.ConclusionChildren with minimal head injuries can be safely discharged with oral and written instructions. Use of the SNC-G will potentially reduce the use of CT.

Clinical and Neurocognitive recovery from Mild and Moderate Head Injury: A Study from a Tertiary care Hospital in Eastern India

Clinical and Neurocognitive recovery from Mild and Moderate Head Injury: A Study from a Tertiary care Hospital in Eastern India

Utility and effectiveness of the Scandinavian guidelines to exclude computerized tomography scanning in mild traumatic brain injury - a prospective cohort study

BackgroundIn 2013 the Scandinavian Neurotrauma Committee (SNC) published updated guidelines for the initial management of minimal, mild and moderate traumatic head injuries (MTHI) that included serum analysis of protein S100B as a marker for brain tissue damage. This study reviews the effectiveness of the new guidelines in a clinical setting.MethodsFor all patients admitted to Akershus University Hospital (AHUS) from June 30th 2014 to December 15th 2014 with MTHI a separate form was filled in recording the time, indication and result of any S100B sampling and/or head computer tomography (CT) examinations. Data from these forms were compared to information derived from the electronic patient records for patients with MTHI and related diagnoses and data from the laboratory for all patients that had undergone the S100B analysis within the same period.ResultsFive hundred seventy-five patients were identified with MTHI, S100B sampling was indicated for 223 (38.8%) patients and carried out for 188 (84.3%) of these patients. 69 (36.7%) of the patients had a negative S100B test, but a head CT scan was still performed in 31 cases despite the negative S100B test. In total the guidelines were followed for 362 of 575 patients (63.0%). 180 (31.3%) of the MTHI cases were discharged without further observation or CT examinations, including 38 (21.1%) as a direct result of S100B testing. No re-admissions or missed initial traumatic brain injuries were observed.ConclusionThe implementation of the updated SNC guidelines resulted in direct discharge of more than one third of the MTHI cases without further observation or CT examinations. One in five of these discharges was a direct result of S100B testing. However, compliance to the guidelines were poor and the guidelines were only followed in 40%. While this study showed benefits of implementing SNC guidelines to reduce the number of CT scans, additional training is needed for optimal use.

Mild traumatic brain injury: evaluation of olfactory dysfunction and clinical–neurological characteristics

ABSTRACTObjective: To evaluate olfactory function and clinical–neurological characteristics in a group of patients with mild head trauma.Methods: A total of 352 patients with MTBI underwent olfactory function evaluation. The site of head trauma, loss of consciousness <20 min, memory loss, subjective presence or absence of olfaction and other clinical, neurological and radiological aspects were evaluated and compared with the olfactory dysfunction.Results: A total of 33.5% patients enrolled in the study had an olfactory dysfunction. Eighty-seven percent of the patients had a diagnosis of anosmia whereas 13% had a diagnosis of hyposmia. Statistical analysis did not show a correlation between radiologically detected head lesions and different types of olfactory dysfunction (p > 0.05). Besides, no difference between head lesion site and different olfactory dysfunction was reported (p = 0.5). Regarding olfactory sub-tests a low detection threshold was present in these patients.Conclusion: The possibility of olfactory dysfunction should be considered in any case of MTBI appears differently than expected, a minor head injury causes anosmia much more frequently than hyposmia.

Endoscope-assisted single burr hole drainage and irrigation of chronic subdural hematoma (SDH): A retrospective analysis

Background: Chronic subdural hematoma (SDH) is usually associated with mild trivial head trauma in the elderly population. Its treatment varies from multiple burr hole, irrigation, twist drill, and craniotomy for membranectomy. Objectives: 1) To describe the operative procedure of single burr hole, drainage, and irrigation assisted by an endoscope in the management of patients with chronic SDH and 2) to present its favorable outcome. Materials and Methods: Seventy-two patients were managed by endoscope-assisted single burr hole, drainage, and irrigation during the period from July 2008 to August 2013. All patients were given local anesthesia. Retrospective data at the times of admission, discharge, and at follow-up at 3 weeks and 6 weeks were analyzed. Results: The mean age of the patients was 65 years and males outnumbered females. Average operation time was 30 min. All patients were discharged at Markwalder's grade 0 within 3-4 days of admission. There were 1.38% cases of seizures but no cases with recurrences or mortality. On follow-up, 86.11% and 100% cases of full brain expansion were achieved at 3 and 6 weeks, respectively. Conclusion: Endoscope-assisted single burr hole drainage and irrigation of chronic SDH is simple, safe, and patient friendly. The short duration of this surgery performed in the elderly patients under local anesthesia is its biggest advantage.

Cognitive contributions to theory of mind ability in children with a traumatic head injury

The objective of the current study is to examine the contribution of intellectual abilities, executive functions (EF), and facial emotion recognition to difficulties in Theory of Mind (ToM) abilities in children with a traumatic head injury. Israeli children with a traumatic head injury were compared with their non-injured counterparts. Each group included 18 children (12 males) ages 7–13. Measurements included reading the mind in the eyes, facial emotion recognition, reasoning the other’s characteristics based on motive and outcome, Raven’s Coloured Progressive Matrices, similarities and digit span (Wechsler Intelligence Scale for Children – Revised 95 subscales), verbal fluency, and the Behaviour Rating Inventory of Executive Functions. Non-injured children performed significantly better on ToM, abstract reasoning, and EF measures compared with children with a traumatic head injury. However, differences in ToM abilities between the groups were no longer significant after controlling for abstract reasoning, working memory, verbal fluency, or facial emotion recognition. Impaired ToM recognition and reasoning abilities after a head injury may result from other cognitive impairments. In children with mild and moderate head injury, poorer performance on ToM tasks may reflect poorer abstract reasoning, a general tendency to concretize stimuli, working memory and verbal fluency deficits, and difficulties in facial emotion recognition, rather than deficits in the ability to understand the other’s thoughts and emotions. ToM impairments may be secondary to a range of cognitive deficits in determining social outcomes in this population.

Comparison of the Canadian CT head rule and the new orleans criteria in patients with minor head injury.

AimThe aim of the study was to compare the New Orleans Criteria and the New Orleans Criteria according to their diagnostic performance in patients with mild head injury.MethodsThe study was designed and conducted prospectively after obtaining ethics committee approval. Data was collected prospectively for patients presenting to the ED with Minor Head Injury. After clinical assessment, a standard CT scan of the head was performed in patients having at least one of the risk factors stated in one of the two clinical decision rules.Patients with positive traumatic head injury according to BT results defined as Group 1 and those who had no intracranial injury defined as Group 2. Statistical analysis was performed with SPSS 11.00 for Windows. ROC analyze was performed to determine the effectiveness of detecting intracranial injury with both decision rules. p < 0.05 was considered statistically significant.Results175 patients enrolled the study. Male to female ratio was 1.5. The mean age of the patients was 45 ± 21,3 in group 1 and 49 ± 20,6 in group 2. The most common mechanism of trauma was falling. The sensitivity and specificity of CCHR were respectively 76.4% and 41.7%, whereas sensitivity and specificity of NOC were 88.2% and 6.9%.ConclusionThe CCHR has higher specificity, PPV and NPV for important clinical outcomes than does the NOC.

Cerebellar cortical abiotrophy in a Samoyed dog

Cerebellar abiotrophies have a non-sex-linked, autosomal, recessively inherited basis in anumber of animal species, and lesions typically reflect progressive loss of Purkinje cells. In this report, ataxia was observed in a one-week-old male Samoyed puppy with no history of trauma or any other illness. Physical examination revealed uncoordinated movements, mild trunkal ataxia and intensive head tremors, so the dog had trouble eating, evacuating and difficulties in standing and walking without falling. The complete cell count, cerebrospinal fluid analysis and cerebral radiographs were normal. Treatment with diazepam, vitamin B1 and glucocorticoids had no effect on clinical signs and the dog died after a month. According to clinical signs and histopathological features, cerebellar cortical abiotrophy was diagnosed. This is the first report of a cerebellar cortical abiotrophy in a Samoyed puppy.

Relationship between the Right Internal Jugular Vein and Carotid Artery at Ipsilateral Head Rotation

Ultrasound-guided right internal jugular vein catheterization (RIJV) should be the first choice to decrease the catheter-related complications in high-risk hemodialysis patients. For this procedure, clinicians should identify the optimum positions of the RIJV, including its lower overlap with the carotid artery (CA) and high cross-sectional area of the vein. The aim of this prospective randomized study to evaluate the effects of mild ipsilateral head rotation combined with Trendelenburg position on RIJV cross-sectional area and its relation to the CA in adult patients. Forty ASA I–II patients who were undergoing elective surgery were enrolled for this study. The subjects were asked to remain supine in the 15–20° Trendelenburg position. Two-dimensional ultrasound was then used to measure the degree of overlap between the RIJV and CA, the cross-sectional area of the RIJV. These measurements were compared between head rotation to the >30° left, <30° left, neutral, and <30° right positions. When the head was in the >30° left position, overlap was seen in 38 of 40 patients (95%). As the head was rotated from >30° left to <30° right, the CA-RIJV overlap (from 95% to 57.5%), and the cross-sectional area (from 14.2 mm to 8.7 mm) significantly decreased. In conclusion, when the head was turned to <30° right, the CA-RIJV overlap significantly decreased, and the cross-sectional area also decreased. When clinicians determine the optimal head position before RIJV cannulation, it is important to consider the advantages and disadvantages of the different head positions from >30° left to <30° right.

Meta - analysis of epidemiology and clinical charateristics of head injuries in the Wenchuan earthquake

Objective To estimate the epidemiology and clinical characteristics of patients with head injuries in Wenchuan Earthquake. Methods A comprehensive study of clinical data and literature meta - analysis evaluation of the 2008 - 2011 published articles on the traumatic brain injuries caused by the Wenchuan earthquake were carried out. Results Totally 68 retrieved documents met the essential requirements.According to the literature inclusion criteria,there were 18 papers were enrolled into the standard meta- analysis.They were sampled from all 3 involved provinces as Sichuan,Shanxi and Gansu.And this covered the 26 earthquake hit and severe hit regions.As the cumulative statistical showed that the earthquake injured 32 415 people,in which 5 559 people had head injuries ( 17.1％ ).The Male:female ratio was 1.53:1.The mild earthquake caused head injuries accounted for 69.4％,moderate 21.0％,and severe 9.6％.The open head injuries accounted for 17.7％ and combined injuries accounted for 54.7％.The mortality rate of earthquake caused head injury mortality rate was 0.16％.Conclusions Head injuries caused by the Wenchuan earthquake have some characteristics such as the high incidence,the complicated injury mechanism,combined injuries,nulti - injuries,rapid clinical changes and so on.And to improve the emergency response to victims of disaster in different stages’ hospitals would play greatly important role in increasing the rescue survival and reducing the disability and death rate. Key words: Earthquake ; Craniocerebral trauma; Epidemiology ; Treatment ; Meta- analysis

Correlation between BIS and GCS in patients suffering from head injury

Glasgow coma scale (GCS) is considered an important parameter to predict the clinical outcome in head injury; however, in some cases such as the use of sedative drugs the estimate of GCS would not be precise. Bispectral index (BIS) is an electrophysiological parameter to determine the clinical state of anesthesia. The aim of the present study is to evaluate correlation between GCS and BIS in patients suffering from head injury and to see if we can use BIS values as a prognostic factor in head trauma. In this analytic study 61 consecutive patients with traumatic head injury admitted to the intensive care unit from January till June 2010 were examined. In each case the GCS and BIS values were measured and compared regarding different degrees of head injuries. Mean BIS in mild injury group was 96.20 ± 3.27 and in moderate injury group was 45.57 ± 1.28 and in severe injury group was 31.37 ± 2.08. There was a significant correlation between GCS and mean BIS (r = 0.88; P < 0.05). Mean BIS values were significantly different between mild, moderate and severe head injuries (96.2 ± 3.2, 45.5 ± 1.2, and 31.3 ± 2.08, respectively; P < 0.05). We found significant correlation between GCS and BIS in patients with traumatic head injury, so BIS can be used in addition to GCS for prediction of outcome in these patients specially in patients who are sedated or are intubated or in other case in whom GCS values cannot be determined accurately.

Management of minor head injury in adults

Head injury accounts for up to 20 per cent of emergency department (ED) attendances (Kay and Teasdale 2001), and approximately 800,000 patients attend U.K. EDs with head injuries every year (National Institute for Health and Clinical Excellence (NICE) 2007a, Scottish Intercollegiate Guidelines Network (SIGN) 2009). About 90 per cent of these patients have a mild or minor head injury and are managed in EDs before being discharged home (Swann and Teasdale 1999). NICE in England and Wales and SIGN in Scotland have issued guidelines for the early management of head injury in adults in an attempt to improve clinical practice. This article discusses the important role of emergency nurses, particularly with regard to discharge information and advice for patients, relatives and carers.

The effect of brain injury terminology on university athletes' expected outcome from injury, familiarity and actual symptom report

Primary objective: To determine the influence of the terms concussion, mild traumatic brain injury and minor head injury on expected injury outcome, term-related familiarity and actual symptom reporting.Research design: A questionnaire varied the terms concussion, mild traumatic brain injury and minor head injury.Methods and procedures: Two hundred and twenty-four university students were allocated one questionnaire version. Participants rated injury outcome statements for their truthfulness, specified term familiarity and completed measures on post-concussion symptoms, anxiety, depression, pain and affectivity. Chi-square tests compared response frequencies of statement ratings and familiarity between questionnaire versions and a rank-based multivariate method compared psychological measures between questionnaire versions.Main outcomes and results: Terminology significantly influenced both expected injury outcome and familiarity. Outcome expectations were reliably more negative for the term mild traumatic brain injury than concussion or minor head injury. Mild traumatic brain injury was the least familiar term. However, terminology groups did not differ in actual symptom reporting.Conclusions: The data showed that the use of terminology affected athletes’ injury outcome expectations and familiarity. The impact of the data and advice for the best term for future use are discussed. While it is not easy to make a clear recommendation, the data clearly indicate a strong need for education of brain injury at university level and possibly beyond.

Deformation mechanisms and impact attenuation characteristics of thin-walled collapsible air chambers used in head protection

Head injuries are a major cause of morbidity and mortality worldwide, many resulting from sporting activities. There is a constant need in the head protection industry for improved methods to manage impacts and to reduce the risk of mild and severe head injuries. Contemporary head protection primarily consists of foam with several inherent disadvantages, including a limited ability to provide effective energy absorption under both low and high impact velocities. Recently, thin-walled collapsible chambers were engineered to address this problem and have been implemented into sport helmets. The chambers consist of four engineering elements which define their dynamic performance: geometry, air volume, material, and venting system. This research analysed the contribution of air flow through an orifice to the chamber's management of impact energy. The objective of this study was to determine the effect of the chamber's vent diameter and material stiffness on peak force and venting rate during an impact. Two material stiffnesses (thermoplastic polyurethane 45D and thermoplastic polyurethane 90A) and five vent diameters (1 mm, 2 mm, 3 mm, 4 mm, and 5 mm) were tested at three inbound velocities (1.3 m/s, 2.3 m/s, and 3.0 m/s). Each chamber was impacted ten times using a monorail drop system. Analysis of the results revealed that the material stiffness, vent diameter, and inbound velocity all had a significant effect on peak force and venting rate (p < 0.001). Under low inbound velocities the largest vent diameters transmitted a lower force than the smallest vent, while this relationship reversed at high inbound velocities. Under low velocities the air flowrate was negatively correlated and the flow duration was positively correlated to the peak force. Under high velocities, the air flowrate was positively correlated and the duration was negatively correlated to the peak force. This suggested that, under low velocities, chambers performed optimally when air was dissipated quickly, for a short duration; however, as the chamber approached a critical failure region, the increased duration and decreased velocity of air released prevented higher peak forces. This research confirmed that the differences in vent diameter and material stiffness significantly affected the impact force characteristics of engineered thin-walled collapsible chambers.

RESUSCITATION FROM HEMORRHAGIC SHOCK WITH HBOC-201 IN THE SETTING OF TRAUMATIC BRAIN INJURY

Outcomes after mild or moderate head trauma are worsened with associated hypotension, and secondary brain injury can be reduced with timely resuscitation. This study was performed to investigate HBOC-201 as a resuscitation therapy in a combined hemorrhagic shock and brain injury model. Anesthetized rats sustained moderate brain injury using a controlled cortical impact device, followed by rapid hemorrhage to a mean arterial pressure of 30 mmHg. After 30 min of hypotension, animals were resuscitated with HBOC-201, autologous shed blood (SB), or lactated Ringer solution (LR). Brain injury was assessed by measurements of cerebral blood flow (CBF) and cerebral vasoreactivity to hypercapnia (CVH) using a laser Doppler flowmeter. Contusion volume was evaluated histologically, and cerebral edema was determined by total water content. The HBOC rats required significantly less resuscitation volume versus LR and SB. The CBF was significantly diminished at 60 min after resuscitation with HBOC (70.1% +/- 3.8% baseline) compared with LR (105.8% +/- 10.1% baseline; P < 0.01) and SB (96.8% +/- 5% baseline; P < 0.05). The CVH was preserved in the HBOC and SB groups. The CVH was significantly diminished compared with baseline in the LR group at 30 min after resuscitation and showed a significant loss compared with HBOC at 60 min after resuscitation. The contusion volume for HBOC (45.1 mm3) and SB (35.1 mm3) was less than LR (63.5 mm3, P < 0.01). Although CBF was diminished after resuscitation in the HBOC group, HBOC-treated animals maintained CVH and experienced significantly smaller contusion volume than those treated with LR. These results suggest that resuscitation with HBOC-201 protects autoregulatory mechanisms and may reduce secondary brain injury in traumatic brain injury.

The effectiveness of cognitive-behavioural therapy for post-traumatic headaches

Post-traumatic headache is one of the most common symptoms following mild and moderate head injury. Psychological factors are believed to play a role in the cause, maintenance and relief from chronic post-traumatic headache. This research evaluated the effectiveness of a multi-dimensional cognitive-behavioural approach towards rehabilitation of post-traumatic headaches. The sample included 20 participants with post-traumatic headaches from an original sample of 41. Participants acted as their own controls. Outcome measures consisted of self-rating questionnaires to assess headache severity, intensity, duration, functioning and emotional well-being. Emotional and functional headache characteristics were studied using a multi-dimensional investigation which included relatives’ perceptions of the sufferers headaches. The intervention proved effective and beneficial for the 20 therapy participants. It is concluded that cognitive-behavioural therapy provides a useful supplement to the treatment of post-traumatic headache.